Case Report
A 3-year-old girl was admitted to our clinic with difficulty in walking beginning 1.5 months before admission. We learned that she had been operated on five times since two months of age with dermal sinüs and tethered cord diagnoses. However, no pathological examination was done for the operation specimens.
Before 1.5 months, when she had difficulty in walking, she was admitted to our hospital, and an intradural mass (2.3x2x1.5 cm) was diagnosed in lumbosacral (L2-S2) spinal MRI (Fig 1). It was operated on, and the mass was totally excised in our neurosurgical department with a diagnosis of intradural abscesses, but the pathological diagnosis was a solid mass containing immature renal cells. Forty percent of it were blastemal nodules. The proliferation index was 2.8 %, and mitosis was rare (Fig 2).
After 1.5 months, the patient was admitted again with the complaints of the increase in difficulty in walking, standing, and balance.
The patient was hospitalized. He had difficulty in walking, and he was incontinent of urine and stool. Physical examination revealed weakness in the lower extremities (muscle strength was 1/5 bilaterally), and deep tendon reflexes were absent. The plantar response was bilateral flexor. Based on the clinical findings, spinal cord compression was considered, and spinal magnetic resonance imaging was performed. Lumbar magnetic resonance imaging showed a mass at the L2-S2 level involving the spinal cord (Fig 3). Urinalysis, renal, and liver function tests were normal. Abdominal ultrasonography and MRI were normal. Surgical resection of the tumor was performed, but the tumor mass could not be completely removed (Fig 4). The histopathological examination of the mass revealed triphasic histology Wilms’ tumor in which blastemal, stromal, and epithelial elements were present (favorable histology) (Fig 5). According to the National Wilms’ Study Group protocol, the tumor was accepted as Stage III.
The patient is six months follow after the surgery. Physical examination reveals the weakness in the right lower extremity (muscle strength 4/5). She has no incontinence. She is still being given chemotherapy and radiotherapy.